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What Is Metastatic Breast Cancer

Seed And Soil Hypothesis

What is the Treatment for Metastatic Breast Cancer?

The “seed and soil” hypothesis states that specific organs harbor metastases from one type of cancer by stimulating their growth better than other types of cancer. This interaction is dynamic and reciprocal, since cancer cells modify the environment they encounter. Tumor embolus = seed and Target organ = soil.

Metastatic Breast Cancer Is Terminal

Metastatic breast cancer cant be cured and it is terminal. One thing I didnt know when I was first diagnosed is that breast cancer can only kill you if you have metastatic breast cancer, says Rosen, who explains that if your cancer remains in the breast, the tumor can be removed, but metastatic means it has spread outside the breast.

MBC is almost like a different disease than early-stage breast cancer, adds Ann Silberman, 60, from Sacramento, California, who was diagnosed in 2009. We are going to die. Our concerns are much different from those of a person who has a treatment that will be over . Someone in an earlier stage may worry about losing their hair which is understandable but they will return to their normal life at some point.

People with metastatic breast cancer expect to be on treatment for the rest of their lives. I dont think everyone understands that, Silberman says. I still get, When will your treatment be over? Well, its never going to be over.

How Do Breast Cancer Cells Spread Around The Body

Breast cancer cells travel through the body like any other cancer cells. Firstly, cancer cells can invade neighbouring healthy tissue. Following this, the cancer cells then invade local lymph nodes or blood vessels.

When breast cancer spreads to the axillary lymph nodes this is still a relatively early stage of metastasis, and potentially curable.

The cancer cells will typically travel through the lymphatic system or blood vessels to other distant parts of the body.

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Symptoms Of Breast Cancer Metastasis To Liver

Metastatic breast cancer may grow silently in the body while you are completely unaware. Early on in metastatic liver cancer there might not be any signs or symptoms to alert you. As the cancer grows, you may experience liver swelling. This may cause the following symptoms:

  • Bloating of your abdomen
  • Mass on upper right abdomen
  • Fever, chills, sweats
  • Confused thinking

Knowing the early symptoms can help you find and treat breast cancer that has metastasized to the liver early on and slow the progression of the disease.

How And Where Does Mbc Spread

Metastatic Breast Cancer

The process starts with a mutation, or error in a normal cells DNA. The DNA error results in cancer cells that reproduce at a very fast rate. The cancer cells spread and highjack healthy cells. In time, new cancer cells move into the bloodstream or the lymphatic system, traveling to other areas in the body. The large vessels become narrow and end in small capillaries, where the cancer cells lodge before dividing and moving into surrounding tissue. Then, at the new location, they take over healthy cells and form a mass. The new tumor, or mass, can grow its own blood vessels to sustain continuing growth and spread.

Breast cancer usually metastasizes, or spreads, to areas such as the bones, the brain, the liver, and the lungs. Metastasis to each vital organ carries its own set of symptoms. Even though it spreads to other parts of the body, its biologic identity remains that of breast cancer, rather than that of the organ tissue it has invaded. Read more about what symptoms you’ll experience in HealthCentral’s slideshow on sites of metastasis.

Youll hear the term stage or staging for breast cancer, which indicates where the breast cancer has spread to, as well as the size. The lower the number, the smaller the size and the less amount of spread. For instance, in Stage IA the tumor is equal to or less than 2 centimeters , which is 3/4 of an inch, and has not spread to lymph nodes or distant sites.

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Types Of Bone Metastases

Normally your bones are constantly changing. New bone tissue is being formed and old bone tissue is breaking down into minerals that circulate in your blood. This process is called remodeling.

Cancer cells upset the normal process of bone remodeling, causing bones to become weak or too dense, depending on the type of bone cells affected.

Your bone metastases may be:

  • osteoblastic, if there are too many new bone cells
  • osteolytic, if too much bone is destroyed

In some cases, your bones may have both types of metastases.

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Mechanisms In Bone Metastases

The primary extracellular matrix components and cell-surface receptors which aid in metastasis are:

Cancer cell-blood platelet interaction

Metastatic breast-cancer cells excrete lysophosphatidic acid which binds to receptors on tumor cells, inducing cell proliferation and release of cytokines and stimulating bone resorption. After the breast-cancer cells have left the primary tumor, they interact with the bone microenvironment and secrete osteolytic factors capable of osteoclast formation and bone resorption. Apart from the breast tumor cells, the resident stromal cells also contribute to tumor survival. Growth factors such as epidermal growth factor , fibroblast growth factor and transforming growth factor beta are implicated in the development and progression of metastatic breast cancer.

Matrix metalloproteinases

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What Are The Chances Of Breast Cancer Recurring

Despite huge advancements in breast cancer screening, early detection and treatment, a percentage of breast cancers will recur and spread to distant sites.

Although at the moment, it is almost impossible to say which cancers will recur and at what time period from diagnosis, there are a few factors that are known to increase the risk for recurrence.

These risk factors include:-

  • Lymph node involvement and number of lymph nodes affected at the time of diagnosis
  • Tumor Size at the time of diagnosis
  • A subtype of Breast Cancer and hormonal receptor Status
  • The time span from the initial diagnosis to recurrence of breast cancer

Local Or Regional Treatments For Stage Iv Breast Cancer

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Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.

Radiation therapy and/or surgery may also be used in certain situations, such as:

  • When the breast tumor is causing an open or painful wound in the breast
  • To treat a small number of metastases in a certain area, such as the brain
  • To help prevent or treat bone fractures
  • When a cancer is pressing on the spinal cord
  • To treat a blood vessel blockage in the liver
  • To provide relief of pain or other symptoms anywhere in the body

In some cases, regional chemo may be useful as well.

If your doctor recommends such local or regional treatments, it is important that you understand the goalwhether it is to try to cure the cancer or to prevent or treat symptoms.

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Are There Different Types Of Mbc

Yes. The most common types of breast cancer are ductal and lobular.

Ductal breast cancers occur within the ducts of the breast, then move through the ductal wall to fatty and fibrous breast tissue.

Lobular cancers begin in the lobule, which is where breast milk is produced. They move through the wall into fat and fibrous tissues without causing scar tissue. They can grow without forming a tumor, which makes them harder to detect.

Inflammatory breast cancer is rare and highly aggressive, and it can be ductal or lobular.

Advanced Cancer That Progresses During Treatment

Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, a woman’s menopause status, general health, desire to continue getting treatment, and whether the hormone receptor status and HER2 status have changed on the cancer cells.

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Factors Influencing Metastatic Breast Cancer Prognosis

There are several factors that can impact the prognosis of metastatic breast cancer, these include:

  • Age
  • Hormone receptors on cancer cells
  • The type of tissue involved
  • The number of tumors/extent of metastasis
  • A persons overall attitude and outlook on the prognosis

Of course, no factors can accurately predict the exact prognosis for a person with metastatic breast cancer. These statistics are based on many clinical research studies, looking at survival rates for people diagnosed with breast cancer at all stages. But the prognosis of each person is different, regardless of what the statistics indicate.

Symptoms Of Metastatic Breast Cancer

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The symptoms of metastatic breast cancer may be different than those of early-stage breast cancer, but not always. Sometimes, there are no symptoms at all.

You should always speak with your doctor if you experience any new signs or symptoms, but here are some of the most common signs that breast cancer has spread:

  • Bone pain or bone fractures due to tumor cells spreading to the bones or spinal cord
  • Headaches or dizziness when cancer has spread to the brain
  • Shortness of breath or chest pain, caused by lung cancer
  • Jaundice or stomach swelling

The symptoms of breast cancer metastasis may also vary depending on where in the body the cancer has spread. For example:

  • If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening in the breast or underarm.
  • If the cancer has spread to bones, symptoms may include pain, fractures or decreased alertness due to high calcium levels.
  • If the cancer has spread to the lungs, symptoms may include shortness of breath, difficulty breathing, coughing, chest pain or fatigue.
  • If the cancer has spread to the liver, symptoms may include nausea, fatigue, swelling of the feet and hands or yellowing skin.
  • If cancer has spread to the central nervous system, which includes the brain or spinal cord, symptoms may include pain, memory loss, headache, blurred or double vision, difficulty with and/or movement or seizures.

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Our Advice To Other Women With Metastatic Breast Cancer: Be Nice To Yourself

Give yourself a break! is the advice that Sendelbach offers. Stop negative self-talk about what you should have done but didnt do, she says. If you have MBC, you need to be kind and loving to yourself.

The body has only so much energy to offer per day, and managing metastatic breast cancer requires a lot of it. So it doesnt make sense to try to compare what youre able to do with what your cancer-free friends are accomplishing.

Just getting through the day can be hard, Sendelbach says. Getting rid of those not good enough feelings can lift a huge weight off you.

What Are The Signs Of Metastatic Breast Cancer

  • What Are the Signs of Metastatic Breast Cancer? Center
  • Metastatic breast cancer is stage IV cancer, which has spread to other parts of the body. Cancers are a group of diseases in which some types of cells turn abnormal and proliferate without control. Cancer can start anywhere and spread to any part of the body, but is named by the organ in which it first develops. Men can also develop breast cancer, although it is rare.

    If breast cancer spreads to the bone, it is still considered metastatic breast cancer that has spread to the bone it is not considered to be bone cancer. In metastatic breast cancer, breast cancer cells break from the primary tumor, travel through blood or lymph fluid, settle into other parts of the body and start growing into new metastatic breast tumors.

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    A Disease No One Gets

    Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.

    âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped found Breast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â

    The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.

    Prognosis Of Tnbc With Bm

    Bone Only Metastatic Breast Cancer, What Is The Best Approach?

    It is important to be able to predict the patients prognosis to customize treatment options as several factors can impact the response. The Karnofsky Performance Status scale has been identified as a reliable prognostic tool with longer survival noted in patients with a KPS 70. One such tool is the Diagnosis-Specific Graded Prognostic Assessment tool that has been used to predict median survival in patients with brain metastases from various primary sites such as lung, breast, melanoma, gastrointestinal, and renal cell carcinoma.25 The prognostic criteria can be different for each tumor subtype.

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    How Breast Cancer Spreads

    Cancer cells can travel from your breast to other organs through your lymph system or bloodstream. Often, breast cancer spreads when it gets into the lymph nodes under your arms . From there, it enters the lymphatic system, a collection of nodes and vessels that are part of your body’s immune system.

    Once the cancer has reached other organs, it forms new tumors.

    Metastatic breast cancer can also start months or years after you’ve finished treatment for an earlier-stage cancer. This is called a distant recurrence.

    Treatments like surgery, radiation, and chemotherapy are good at removing or killing cancer cells. But sometimes, they can leave a few cancer cells behind. Even a single cancer cell can grow into a new tumor that spreads to other parts of your body.

    Coping With Your Diagnosis

    Being diagnosed with metastatic HER2-positive breast cancer can cause a lot of feelings. It is a life-altering diagnosis, and feelings can range from fear to anger. Finding support from friends or family can be important as you go through the steps of diagnosis and treatment. There are many support groups, both in person and virtual, as well as many websites with helpful information in navigating this journey.

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    What Are The Differences Between Metastatic Breast Cancer Stage 4 Breast Cancer And Advanced Cancer

    “Most of us use the names stage 4 and metastatic interchangeably,” Henry says. “Advanced is a little more complicated. Sometimes you will see the word ‘advanced’ used to describe metastatic cancer. But sometimes you will see the term ‘locally advanced.’ That means there’s a lot of cancer in the surrounding lymph nodes, but it doesn’t necessarily mean we see cancer that has spread outside of the area. We tend to stay away from the word ‘advanced’ because there can be confusion.”

    If any doctor uses the term “advanced,” ask for clarification, Henry adds.

    Every patient is different. In most cases, it arises months or years after a person has completed treatment for the initial breast cancer diagnosis, Henry says.

    But some patients will learn they have metastatic breast cancer when first diagnosed, a term known as de novo metastatic breast cancer, Henry says. Only 6% of women and 8% of men receive a de novo metastatic diagnosis, according to Komen.

    Symptoms Of Metastatic Cancer

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    Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:

    • pain and fractures, when cancer has spread to the bone
    • headache, seizures, or dizziness, when cancer has spread to the brain
    • shortness of breath, when cancer has spread to the lung
    • jaundice or swelling in the belly, when cancer has spread to the liver

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    What Makes Metastatic Breast Cancer Different

    You may have heard doctors or the media talk about breast cancer as a disease that can be treated and then ends. At the end of treatment for your first diagnosis, maybe you felt your experience was over. Perhaps your doctors mentioned the chance of recurrence, but it sounded unlikely.

    There are many people who undergo treatment and never have to deal with cancer again. A metastatic breast cancer diagnosis is different because it means you will actively deal with breast cancer for the rest of your life.

    With metastatic breast cancer, the goal of treatment is to shrink or weaken the cancer, manage your symptoms and side effects and prevent the cancer from spreading further. Changes in treatment are made as the cancer grows or spreads to new places in your body. You and your doctors will talk regularly about progression, the growth of tumors or spread of cancer, and regression, decreases in tumor size or the cancers reach. When one treatment stops working, you and your doctors will look at new options.

    When talking with your doctor, ask about treatment side effects. Maintaining your usual daily activities and being able to participate in the things you enjoy are essential to your overall well-being. It may be helpful to talk openly with your medical team about how symptoms and side effects impact you every day.

    Treatment for metastatic breast cancer has two main goals: to control the cancer for as long as possible, with the highest quality of life possible.


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